Pros and Cons of Radiotherapy Omission in Elderly Breast Cancer Patients Following Breast Conservative Surgery

Overview

Journal Transl Cancer Res

Specialty Oncology

Date 2022 Feb 4

PMID 35117967

Authors

Icaro T Carvalho

Ana C P Rezende

Renata J C Bernardo

Affiliations

Soon will be listed here.

Abstract

Breast cancer is a highly prevalent disease worldwide, with adjuvant radiation therapy (RT) being considered standard of care after breast-conserving surgery (BCS). Older patient population can present multiple running comorbidities and less aggressive tumor behavior, and the absolute impact of adjuvant RT on local control can be low. This article aims to review the available literature about the impact of adjuvant RT, discussing characteristics to identify lower risk cases, and advantages and disadvantages of the omission of adjuvant radiotherapy in this group.

Citing Articles

The effect of adjuvant radiotherapy after breast-conserving surgery in elderly women with T1-2N0 estrogen receptor-negative breast cancer.

Chen C, Wang R, Wang B, Wu Y, Jiang J PLoS One. 2023; 18(8):e0288078.

PMID: 37535561 PMC: 10399868. DOI: 10.1371/journal.pone.0288078.

Special Techniques of Adjuvant Breast Carcinoma Radiotherapy.

Kolarova I, Melichar B, Vanasek J, Sirak I, Petera J, Horackova K Cancers (Basel). 2023; 15(1).

PMID: 36612294 PMC: 9818986. DOI: 10.3390/cancers15010298.

The addition of radiotherapy to breast-conserving surgery improves survival for elderly patients with early breast cancer.

Yang S, Tan L, Zhou P, Lian C, Wu S, He Z Front Oncol. 2022; 12:917054.

PMID: 36505844 PMC: 9727219. DOI: 10.3389/fonc.2022.917054.

Decreases in Radiation Oncology Medicare Reimbursement Over Time: Analysis by Billing Code.

Hogan J, Roy A, Karraker P, Pollock J, Griffin Z, Vapiwala N Int J Radiat Oncol Biol Phys. 2022; 114(1):47-56.

PMID: 35613687 PMC: 10077845. DOI: 10.1016/j.ijrobp.2022.05.018.

References

Coleman M, Quaresma M, Berrino F, Lutz J, De Angelis R, Capocaccia R . Cancer survival in five continents: a worldwide population-based study (CONCORD). Lancet Oncol. 2008; 9(8):730-56. DOI: 10.1016/S1470-2045(08)70179-7. View

Kunkler I, Williams L, Jack W, Cameron D, Dixon J . Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): a randomised controlled trial. Lancet Oncol. 2015; 16(3):266-73. DOI: 10.1016/S1470-2045(14)71221-5. View

Fisher B, Anderson S, Bryant J, Margolese R, Deutsch M, Fisher E . Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002; 347(16):1233-41. DOI: 10.1056/NEJMoa022152. View

Rhieu B, Rajagopalan M, Sukumvanich P, Kelley J, Ahrendt G, Heron D . Patterns of care for omission of radiation therapy for elderly women with early-stage breast cancer receiving hormonal therapy. Pract Radiat Oncol. 2015; 5(4):e267-73. DOI: 10.1016/j.prro.2014.12.003. View

Hughes K, Schnaper L, R Bellon J, Cirrincione C, Berry D, McCormick B . Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343. J Clin Oncol. 2013; 31(19):2382-7. PMC: 3691356. DOI: 10.1200/JCO.2012.45.2615. View

Smith B, Buchholz T . Radiation treatments after breast-conserving therapy for elderly patients. J Clin Oncol. 2013; 31(19):2367-8. DOI: 10.1200/JCO.2012.48.0939. View

Albert J, Liu D, Shen Y, Pan I, Shih Y, Hoffman K . Nomogram to predict the benefit of radiation for older patients with breast cancer treated with conservative surgery. J Clin Oncol. 2012; 30(23):2837-43. PMC: 3410401. DOI: 10.1200/JCO.2011.41.0076. View

de Mascarel I, Bonichon F, MacGrogan G, de Lara C, Avril A, Picot V . Application of the van nuys prognostic index in a retrospective series of 367 ductal carcinomas in situ of the breast examined by serial macroscopic sectioning: practical considerations. Breast Cancer Res Treat. 2000; 61(2):151-9. DOI: 10.1023/a:1006437902770. View

Hughes K, Schnaper L, Berry D, Cirrincione C, McCormick B, Shank B . Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. N Engl J Med. 2004; 351(10):971-7. DOI: 10.1056/NEJMoa040587. View

10.

Horton J, Jagsi R, Woodward W, Ho A . Breast Cancer Biology: Clinical Implications for Breast Radiation Therapy. Int J Radiat Oncol Biol Phys. 2017; 100(1):23-37. DOI: 10.1016/j.ijrobp.2017.08.025. View

11.

Warnberg F, Garmo H, Emdin S, Hedberg V, Adwall L, Sandelin K . Effect of radiotherapy after breast-conserving surgery for ductal carcinoma in situ: 20 years follow-up in the randomized SweDCIS Trial. J Clin Oncol. 2014; 32(32):3613-8. DOI: 10.1200/JCO.2014.56.2595. View

12.

Rakovitch E, Nofech-Mozes S, Hanna W, Sutradhar R, Gu S, Fong C . Omitting radiation therapy after lumpectomy for pure DCIS does not reduce the risk of salvage mastectomy. Breast. 2017; 37:181-186. DOI: 10.1016/j.breast.2017.07.002. View

13.

Correa C, McGale P, Taylor C, Wang Y, Clarke M, Davies C . Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast. J Natl Cancer Inst Monogr. 2010; 2010(41):162-77. PMC: 5161078. DOI: 10.1093/jncimonographs/lgq039. View

14.

Fyles A, McCready D, Manchul L, Trudeau M, Merante P, Pintilie M . Tamoxifen with or without breast irradiation in women 50 years of age or older with early breast cancer. N Engl J Med. 2004; 351(10):963-70. DOI: 10.1056/NEJMoa040595. View

15.

Pierga J, Girre V, Laurence V, Asselain B, Dieras V, Jouve M . Characteristics and outcome of 1755 operable breast cancers in women over 70 years of age. Breast. 2004; 13(5):369-75. DOI: 10.1016/j.breast.2004.04.012. View

16.

Williams L, Kunkler I, King C, Jack W, van der Pol M . A randomised controlled trial of post-operative radiotherapy following breast-conserving surgery in a minimum-risk population. Quality of life at 5 years in the PRIME trial. Health Technol Assess. 2011; 15(12):i-xi, 1-57. DOI: 10.3310/hta15120. View

17.

Diab S, Elledge R, Clark G . Tumor characteristics and clinical outcome of elderly women with breast cancer. J Natl Cancer Inst. 2000; 92(7):550-6. DOI: 10.1093/jnci/92.7.550. View

18.

Soulos P, Yu J, Roberts K, Raldow A, Herrin J, Long J . Assessing the impact of a cooperative group trial on breast cancer care in the medicare population. J Clin Oncol. 2012; 30(14):1601-7. PMC: 3383112. DOI: 10.1200/JCO.2011.39.4890. View

19.

Peppercorn J, Jimenez R . Breaking Up Is Hard to Do: Omission of Radiation Therapy for Select Women Aged >70 Years With Breast Cancer. Int J Radiat Oncol Biol Phys. 2017; 98(4):918-921. DOI: 10.1016/j.ijrobp.2017.03.006. View

20.

R Bellon J . Personalized Radiation Oncology for Breast Cancer: The New Frontier. J Clin Oncol. 2015; 33(18):1998-2000. DOI: 10.1200/JCO.2015.61.2069. View